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For my Cleveland patients, Medicaid expansion has been a matter of life and death: James Misak

Updated July 5, 2017 at 5:20 AM;Posted July 5, 2017 at 5:19 AM

MetroHealth Life Flight personnel wheel a patient into the emergency room in this 2009 file photo. In the op-ed below, Dr. James Misak, a MetroHealth family doctor, predicts a return to more expensive, less effective emergency-room health care -- and a rise in preventable deaths -- if the Ohio legislature freezes the state's Medicaid expansion by overriding Gov. John Kasich's recent veto.

MetroHealth Life Flight personnel wheel a patient into the emergency room in this 2009 file photo. In the op-ed below, Dr. James Misak, a MetroHealth family doctor, predicts a return to more expensive, less effective emergency-room health care -- and a rise in preventable deaths -- if the Ohio legislature freezes the state's Medicaid expansion by overriding Gov. John Kasich's recent veto.(Gus Chan, The Plain Dealer, File, 2009)

CLEVELAND -- I am a Cleveland family physician. For more than 25 years I have had the great privilege of caring for patients participating in Ohio's Medicaid program.

I am deeply concerned about the effect that ending Ohio's Medicaid expansion would have on the health of my patients and the well-being of our state.

Since Ohio expanded Medicaid in 2014, many of my patients who were previously uninsured are among the 700,000 Ohioans who can now afford medications and treatments, get their chronic illnesses under control, return to work, and become more engaged in their families and communities. Many of them call the Medicaid expansion a lifesaver.

My patient Mary is a diabetic who lost her job, became uninsured, and could no longer afford her diabetes medications and testing supplies. After repeated trips to the emergency room when a diabetic crisis would arise, she became eligible for the Medicaid expansion. After working with my medical team and having access to needed medications, Mary's diabetes is now under control, she is back at work, and she says she's never felt better.

My patient Joe went to the emergency room one day with a cough, and was told that a chest X-ray showed a spot on his lungs. Uninsured, Joe went without medical care for months until the Medicaid expansion provided coverage. After seeing me and getting the appropriate testing, Joe was diagnosed with early stage lung cancer, which thankfully was treated while still curable. Joe is now back at work.

Due largely to the Medicaid expansion, the number of uninsured in Ohio has been cut nearly in half. Medicaid expansion enrollees report an increased ability to work, better identification and treatment of chronic physical and mental health conditions, less family financial stress and medical debt, and an increase in their ability to pay nonmedical bills. This is exactly what health insurance is supposed to do.

The costs of care for the uninsured borne by hospitals in Medicaid expansion states, like Ohio, have decreased by more than one-third. Because of this, many of Ohio's smaller and more rural hospitals, often the largest and best employers in their regions, have become more financially stable and better able to serve their communities.

Ohio's Medicaid program is one of the most effective and efficient in the nation. It is a national leader in rewarding doctors and hospitals who deliver cost-effective care.

Ending the Medicaid expansion will disrupt the health care of more than half a million Ohioans. It will create barriers to receiving the right health care -- the care that happens when people have access to primary-care doctors like me, who can keep people healthy, prevent some illnesses, and treat others before they become more serious.

The right care happens when doctors like me can coordinate the care of our patients, helping them see the right specialists in the right settings, and not relying on the emergency room or the hospital ward for expensive, uncoordinated care.

The right care happens when doctors like me can treat the whole person, accessing mental health care and addiction care when needed, so that the chances of full recovery are enhanced.

Ending Ohio's Medicaid expansion will not decrease the need for care. It will shift the financial burden of that care to health care providers, diverting limited resources from other critical health care needs. It will make care more expensive, as the now-uninsured avoid care until treatable conditions become so severe as to cause emergency department visits and hospitalizations that could have been avoided with the right care.

I urge Ohio's senators and representatives to continue the Medicaid expansion, to protect the health of all of their constituents and enhance the well-being of the communities they represent.

Dr. James Misak is vice chair of community and population health in the MetroHealth System's Department of Family Medicine and an assistant professor of family medicine in the Case Western Reserve University School of Medicine.

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